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Patulous Eustachian tube, also known as
patent Eustachian tube, is the name of a rare
physical disorder where the Eustachian tube, which is normally
closed, instead stays intermittently open. When this occurs, the
patient experiences autophony, the hearing of self-generated
sounds. These sounds, such as one's own breathing, voice, and
heartbeat, vibrate directly onto the ear drum and can create a
"bucket on the head" effect.

Contents

Symptoms

Patulous Eustachian tube sounds very similar to the standard congestion one gets from
a cold or allergies, though there are subtle
differences. The effect is often described as "drier"; with normal
congestion, breathing and talking echo in the head with a muffled
sound. With patulous Eustachian tube, all breaths echo on the
eardrum without the muffled effect. Similarly, external noises such
as the voices of other people are also not muffled. In addition,
patulous Eustachian tube generally feels dry with no clogged
feeling or sinus pressure.

Some patients with this condition are debilitated by the
perceived volume of their voice, causing them to speak very
quietly. Their own voice may also sound lower to other people,
because the trachea has more volume when the Eustachian tube is
open. The patient may also sound as if they have congestion when
speaking. Some sufferers may have difficulty in normal activities.
Increased breathing rate, such as that brought on by physical
activity, would cause more air to be pushed onto the eardrum more
frequently, which can become quite loud and sometimes lead to a
period of increased tinnitus after exertion.

Diagnosis

Upon examination of a suspected case of patulous Eustachian
tube, a doctor can directly view the tympanic membrane
with a light and observe that it vibrates with every breath taken
by the patient. A tympanogram may also help with the
diagnosis. Patulous Eustachian tube is likely if brisk inspiration
causes a significant pressure shift.

Patulous Eustachian tube is frequently misdiagnosed as standard
congestion due to the similarity in symptoms and rarity of the
disorder. Audiologists are more likely to recognize
the disorder, usually with tympanometry or nasally delivered
masking noise during a hearing assessment, which is highly
sensitive to this condition.[1].

When misdiagnosis occurs, a decongestant medication is sometimes
prescribed. This type of medication aggravates the condition, as
the Eustachian tube relies on sticky fluids to keep closed and the
drying effect of a decongestant would make it even more likely to
remain open and cause symptoms. The misdiagnosed patient may also
have tubes surgically inserted into the eardrum, which increases
the risk of ear infection and will not alleviate patulous
Eustachian tube. If these treatments are tried and failed, and the
doctor is not aware of the actual condition, the symptoms may even
be classified as psychological.

Incidentally, patients who instead suffer from the even rarer
condition of superior canal dehiscence are
at risk for misdiagnosis of patulous Eustachian tube due to the
similar autophony in
both conditions.

Causes

Patulous Eustachian tube is a physical disorder. The exact
causes may vary depending on the person. Weight loss is a commonly cited cause of
the disorder due to the nature of the Eustachian tube itself. Fatty
tissues hold the tube closed most of the time in healthy
individuals. When circumstances cause overall body fat to diminish,
the tissue surrounding the Eustachian tube shrinks and this
function is disrupted.[2]

Activities and substances which dehydrate the body have the same
effect and are also possible causes of patulous Eustachian tube.
Examples are stimulants (including caffeine) and exercise. Exercise
may have a more short-term effect than caffeine or weight loss in
this regard.

Pregnancy can also be a cause of patulous Eustachian tube due to
the effects of pregnancy hormones on surface tension and mucous in
the respiratory system.[3]

Treatment

There are few standard medical treatments and "home remedies"
for patulous Eustachian tube, only one has been developed as a
result of scientific studies monitored by the FDA. Recently,
Patulous Eustachian Tube disorders have been alternatively
identified as Di Bartolomeo Syndrome.

Historically, to temporarily alleviate symptoms, patients may
try to tilt their head to one side or upside down, lie down on
their backs, or sit in a chair with their head between their knees.
Similarly, a routine of lying down four times per day with legs
elevated to around 20 inches for at least two weeks may give longer
improvement in some cases. Depending on the underlying cause of the
disorder, the individual may need to remove caffeine from their
diet, reduce exercise, or gain weight.

Medically, the pharmaceutical Patul-END nasal drops have been
improved. The new formulation is drug free and available
Over-the-Counter without a prescription. At this point in time it
is available only by direct order from the developer J. Di
Bartolomeo, M.D. through the research website http://www.earfdn.org. In extreme cases surgical
intervention may attempt to "bulk up" the Eustachian tube tissues
with fat, gel foam, or cartilage or scar it closed with cautery.
These methods are not always successful.

More recently, Canadian doctors have found that applying a
pea-sized dollop of Blu-Tack to the eardrum reduces vibrations and
may provide relief. Trials are said to be starting soon and the
procedure itself can be performed in under a minute without
anesthesia by an ear nose and throat doctor. The Blu-Tack has to be
replaced at regular intervals. [4]